Itemized Bill Demand and 501(r) Charity Care Application Notice
Stage-2 follow-up to a medical bill dispute. Use when the provider ignored your dispute, refused to itemize in CPT/HCPCS codes, sent the bill to collections during your open dispute, or reported it to credit bureaus. Invokes the No Surprises Act, 501(r) charity care for nonprofit hospitals, FCRA medical-debt credit reporting protections, and state supplemental rules.
Statute of Limitations Warning
Legal deadlines apply to your claim. You lose your right to act if you wait too long. Send notice as soon as possible.
Why this letter works:
- Cites the exact law: Automatically applies the correct state and federal statutes to your situation.
- Sets a firm deadline: Legally compels a response within the required statutory timeframe.
- Creates a paper trail: Designed to serve as Exhibit A if you need to escalate to an agency or court.
Answer a few questions and we'll create your personalized letter.
One-time price:$19Paid once at the end. No subscription.
Your Action Plan
This letter is part of a formal escalation process.
Download your personalized PDF immediately after purchase and send it.
Your letter includes a firm deadline. Do not engage in informal text messages during this time.
If they miss the deadline, return to us using the link in your email receipt. You will unlock the next stage document at a discounted rate.
Your Prior Dispute
Confirm what you sent before, the bill, and what the provider did next.
Nonprofit hospitals are required to offer charity care under 26 U.S.C. § 501(r). If unsure, search the provider name + 'IRS Form 990' — nonprofits file Form 990 publicly.
Used only to invoke 501(r) charity care for nonprofit hospitals. Most charity-care policies cover patients up to 200-400% of the federal poverty level.
Before you start
What exactly do I get, and when?
A personalized PDF letter, written around the statute that applies to your situation, with the deadline and the consequence spelled out. It downloads the moment payment confirms, back here on commoner-law.com — there is no waiting period and no account to create. You can also add certified mail at checkout and we will send the physical letter for you.
How much is it?
$19, once. Not a subscription, and nothing is charged until you complete payment on Stripe at the end of the wizard. Any add-ons you select show their own price before you pay.
Is this legal advice?
This is a self-help legal template, not legal advice. Medical billing involves overlapping federal, state, insurance-contract, and Medicaid/Medicare rules. For very high bills, active collection lawsuits, or denials of charity care, consult a licensed attorney or qualified patient advocate.
What if I need to change something afterwards?
Tell us and we will either adjust the letter and send you the updated version at no cost, or refund you in full — your choice. If we can’t deliver what you paid for, the refund is automatic. Full terms are on our promise page.
Do I have to pay to know if I have a case?
No. The rights encyclopedia on this site is free and cites the same primary sources the letter does. Read the relevant guide first — plenty of situations are resolved by a phone call to a free statutory body, and where one exists we say so.